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General NPI Number Information
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NPI Number | 1861227795
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Entity Type | Individual
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Provider Name | NICKOLAS HALPIN
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Gender | Male
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Dates
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Enumeration Date | 09/02/2024
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Last Update Date | 09/02/2024
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Provider Practice Location Address
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Address Line | 2330 N 75TH AVE
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City | PHOENIX
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State | AZ
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Zip | 85035-1200
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Country | US
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Telephone | 602-329-5632
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Fax |
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Provider Business Mailing Address
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Address Line | 3040 E SHEA BLVD APT 2166
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City | PHOENIX
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State | AZ
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Zip | 85028-3229
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Country | US
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Telephone | 715-226-0536
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MT-29868
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License Number State | AZ
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